CEO leads San Diego Hospice through changing world of health care

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Kathleen Pacurar’s daily goal is to provide the best care for patients and their families.

As president and CEO of San Diego Hospice, Pacurar said this philosophy affects every decision she makes, from how resources are used and what new programs are put in place to the research and development conducted by the Institute of Palliative Medicine, a teaching and research affiliate of the University of California, San Diego; San Diego State University; and the University of San Diego.

San Diego Hospice, founded in 1977, provides care for terminally ill patients and support for their families, focusing on comfort, quality of life and relief of pain. It is one of the 10 largest hospice programs in the country, with a staff of 850 and 750 volunteers caring for a thousand patients each day in homes and facilities throughout the county.

The organization’s interdisciplinary, whole-person approach to care considers the mind, body and spiritual needs of patients during the last months of life. It is one of very few hospice centers in the nation to offer psychiatric services, for which it won a Gold Achievement Award from the American Psychiatric Association in 2009.

While patient care is always at the forefront of Pacurar’s vision, she is also focused on the financial stability and growth of San Diego Hospice.

“What we do is very heartfelt and it’s very compassionate and caring,” Pacurar said. “We’re a nonprofit, but at the end of the day we’re also a business that needs to have a strong financial model in place.”

Kathleen Pacurar

San Diego Hospice has a budget of $84 million, with the majority of funding derived from Medicare, MediCal, HMOs and private insurance plan reimbursements. Philanthropy accounts for about $7.5 million.

“In regular times, we would’ve anticipated an increase in philanthropy, and we haven’t seen that. But we still haven’t seen a decrease, which I consider amazing. The community has been extraordinarily supportive,” Pacurar said.

The nonprofit saw rapid growth in the last decade, and is now implementing a financial plan that will take it through the coming years. Pacurar believes the organization will continue its growth trajectory, particularly in light of the aging population.

“We’re going to have to grow, and grow wisely. That’s why it’s important for me to have strong operational health so that we can grow well,” she said. “We keep looking at statistics of the population and how people are living longer. Not just hospice, but all health care organizations are dealing with people needing placement, and how do you care for somebody who’s chronically ill?

“These are going to be huge issues to deal with. For me, the most important thing I can be doing is preparing my organization, because in the next decade, things are going to change, and our services are going to be needed more and more.”

One way Pacurar anticipates hospice care changing in the coming years is through technology. The organization has already switched over to electronic medical records and is beginning to make use of telemedicine.

San Diego Hospice has two inpatient facilities, including its main campus in Hillcrest, with a total of 36 beds. Of her 1,000 patients, about a third are in skilled nursing facilities, and the rest are in their homes.

“We’re dealing with patients that most of them are pretty acutely ill, and we’re trying to manage health care in the home,” she said. “So you can imagine how important communication is, tracking what’s happening with that patient.

“As technology gets more sophisticated, it’s a challenge to switch over. How do you train someone to have wonderful bedside interaction and chart at the same time? This is really the new world that we’re exploring and training in, and it’s our new reality,” she said.

Pacurar is also focused on awareness and educational programs aimed at both the community and professional caregivers. Since patients often find hospice care through physician referrals, education among the medical community is imperative, she said.

Her own awareness of hospice care came early on. Pacurar’s mother was one of the first hospice nurses in the area, so she “grew up with the concept,” she said.

“It’s in my DNA.”

Before her role as CEO, Pacurar served as chief development officer for San Diego Hospice Foundation, the fundraising arm of the organization. Prior to that she was executive director of UCSD Health Sciences Development, supporting programs such as the Shiley Eye Center expansion, the Moores Cancer Center development and the creation of the Sulpizio Cardiovascular Center.

“Being in development my whole career, particularly in health care, one of the most important roles you play is knowing the community,” she said. “One of the really important things that has happened over the last decade in fundraising is being keenly aware of a nonprofit’s financial viability – the importance that an organization is being a good steward to philanthropy.”

Contributions may become even more important to the organization as Medicare reimbursements continue to decline and uncertainties remain about health care reform. In addition, tighter regulations and more oversight will come with higher costs, she said.

“We’re in uncharted territory. Any health care leader you talk to right now will say this is one of the most interesting and challenging times,” she said. “Finances are tight everywhere. So how do you as an organization adapt and do what it is that will be most important in the community, and really do that well?”

She said San Diego Hospice will adapt by focusing on its core: offering meticulous palliative and end-of-life care.

“You can bet that our resources will be focused on that day of patient care. If you do that one thing that you’re really good at just excellently, we’ll be able to get through all of this.”